Pamela Cremin Workforce Planning & Development Manager NHS Highland

1. Pamela Cremin Workforce Planning & Development Manager NHS Highland

2. Aims and structure of this session Six Steps: Step 2 Identify drivers for change from SWOT / PESTLE Identify the benefits of service change What are the drivers that support change? What are the forces that hamper change? Group Work: Carry out a Force Field Analysis Identify areas for action to reduce resistance to change Develop an action plan Agree the plan with stakeholders and secure “buy-in”- How?

3. Step 2: Mapping Forces for Change

4. What is the outcome you are trying to achieve? Vision Values Goals, targets and objectives Structuring Values

5. Step 2: The Context of Change • e.g. • Strategy • Structures • Mission • Products • Services • Practices • Technology • e.g. • Roles • Responsibilities • Methods • Thinking • Values • Behaviours Organisational Responses Personal Implications Interaction Environmental Shifts • e.g.Customers, Competitors, Stakeholders, Economy • Government, Technology, Society

6. Why, What & How? The why The what The how • Environmental shifts • Customers • Competitors • Stakeholders • Economy • Government • Technology • Society • Organisational Responses • Strategy • Structures • Mission • Products • Services • Practices • Technology • Personal Implications • Roles • Responsibilities • Methods • Thinking • Values • Behaviours

7. Force Field Analysis • Analysis tool used to identify forces that help or hinder a change or solution - it is a specialised method of weighing pros and cons • Helps teams focus on change from the “current state” to the “desired state” • Highlights both weaknesses and strengths, pros and cons, barriers and opportunities • Determine if change is feasible/viable

8. Force Field Analysis Application • Assist in the analysis of cause and effect • Assessment of the strength of opposing forces • Help analyse and prioritise solutions to problems or areas needing improvement

9. Force Field Analysis: The methodology in general Steps Draw the field Describe your plan or proposal for change in the middle. List all driving forces for change in one column, and all restraining forces against change in another column. Assign a score to each force, from 1 (weak) to 5 (strong). Identify the goal, draw the status-quo. Select restraining forces to remove or reduce. Brainstorm actions that remove or reduce restraining for forces Create a list of actions that will reduce resistance to change. Prioritise the list of actions, select one, and create an action plan.

10. Drivers for Change Resistance to Change Timescale (5) Current non-compliant rotas (3) Lack of consistent application of rotas across NHSH (3) Assumptions about solutions from NW&AHP (2) Silo working in directorates and traditional ways of working leading to status quo: Inability to combine rotas (4) Guidance from BMA; Royal Colleges etc (3) A Worked Example: WTD Implementation at NHS Highland Proposal for Change: Achieve Working Time Directive Compliance for Junior Doctors by 1st August 2009 Health and Safety (5) Financial Penalty (5) Legislation (5) Drivers for Change : 15 Resistance against Change : 20 20:15 against the plan…

11. A Worked Example: WTD • Actions to reduce resistance: • Identify non-compliant rotas (-3) • Analysis and reports (consistency) (-3) • Engage NM&AHP colleagues to examine solutions (-2) • Meet with HoS re feasibility to combine rotas (-4) • Identifying the levers you can do something about swings the balance from 20:15 against the plan to 8:15 in favour of the plan. (in this example the drivers for change are legislative and cannot be altered) • The Actions identified to reduce resistance can be prioritised and Action Planned. • Key point: • Force Field Analysis is a useful technique for looking at all the forces for and against a plan. It helps you to weigh the importance of these factors and decide whether a plan is worth implementing.Where you have decided to carry out a plan, Force Field Analysis helps you identify changes that you could make to improve it.

12. Force Field Analysis: Group Work • Steps • Individually • Draw the field (paper copy in your pack). • Describe your plan or proposal for change in the middle. • List all driving forces for change in one column, and all restraining forces against change in another column. • Assign a score to each force, from 1 (weak) to 5 (strong).

13. With the rest of the people at your table: • Individually share your Force Field Analysis. • As a group, chose one to work on as a group: • Brainstorm actions that remove or reduce restraining for forces • Select restraining forces to remove or reduce (Levers) • Create a list of actions that will reduce resistance to change. • Prioritise the list of actions, select one, and create an action plan.

14. In your table groups … Identify an example of a service area/specialty that you have worked with to identify and agree change? What have been the main barriers to implementing change in this area? What has helped? What lessons have you learnt for next time?

15. Working with Resistance to Change • Some tips… • Strategies for overcoming and reducing resistance to change • Education and Communication • Participation and Involvement • Facilitation and Support • Negotiation and Agreement • Manipulation and Co-option • Explicit and implicit coercion

16. Any Questions?